[Program of hearing loss early detection in newborn infants in Cantabria. Results of the first year of activities]

Prevalence of permanent childhood hearing loss detected at the universal newborn hearing screen: Systematic review and meta-analysis

CONTEXT

Permanent childhood hearing loss (PCHL) can affect speech, language, and wider outcomes. Adverse effects are mitigated through universal newborn hearing screening (UNHS) and early intervention.

OBJECTIVE

We undertook a systematic review and meta-analysis to estimate prevalence of UNHS-detected PCHL (bilateral loss ≥26 dB HL) and its variation by admission to neonatal intensive care unit (NICU). A secondary objective was to report UNHS programme performance (PROSPERO: CRD42016051267).

DATA SOURCES

Multiple electronic databases were interrogated in January 2017, with further reports identified from article citations and unpublished literature (November 2017).

STUDY SELECTION

UNHS reports from very highly-developed (VHD) countries with relevant prevalence and performance data; no language or date restrictions.

DATA EXTRACTION

Three reviewers independently extracted data and assessed quality.

RESULTS

We identified 41 eligible reports from 32 study populations (1799863 screened infants) in 6195 non-duplicate references. Pooled UNHS-detected PCHL prevalence was 1.1 per 1000 screened children (95% confidence interval [CI]: 0.9, 1.3; I2 = 89.2%). This was 6.9 times (95% CI: 3.8, 12.5) higher among those admitted to NICU. Smaller studies were significantly associated with higher prevalences (Egger's test: p = 0.02). Sensitivity and specificity ranged from 89-100% and 92-100% respectively, positive predictive values from 2-84%, with all negative predictive values 100%.

LIMITATIONS

Results are generalisable to VHD countries only. Estimates and inferences were limited by available data.

CONCLUSIONS

In VHD countries, 1 per 1000 screened newborns require referral to clinical services for PCHL. Prevalence is higher in those admitted to NICU. Improved reporting would support further examination of screen performance and child demographics.

Quality indicators in a newborn hearing screening service

INTRODUCTION

Newborn hearing screening (NHS) programs are implemented across the globe to detect early hearing impairment. In order to meet this objective, the quality of these programs should be monitored using internationally recognized indicators.

OBJECTIVE

To evaluate a newborn hearing screening service (NHSS) using international quality indicators.

METHODS

A retrospective cohort study on the NHSS of Minas Gerais was conducted, analyzing the services performed between 2010 and 2011. Results were analyzed according to criteria from the American Academy of Pediatrics and the Joint Committee on Infant Hearing.

RESULTS

This study assessed 6987 children. The proportions of cases that were referred for a retest, that followed through with retest, and that were referred for diagnosis were 8.0%, 71.9%, and 2.1%, respectively. The proportion of assessed newborn children in the first 30 days of life in this study was 65%. The median age of those children who failed both the NHS and the retest was significantly higher than the other children. The chance of a child with a hearing impairment risk indicator to fail the NHS was 2.4 times higher than of those without a risk indicator.

CONCLUSION

NHSS achieved three of four evaluated indicators. Despite this, it is still necessary to perform NHS earlier and to ensure that the subsequent steps are followed.

[Universal newborn hearing screening in Cantabria (Spain): results of the first two years]

AIMS

We present the results of the first 2 years of universal newborn hearing screening in Cantabria.

MATERIAL AND METHODS

We performed a descriptive study of screening with two levels of transient evoked otoacoustic emissions in 8,836 newborns, diagnostic confirmation with auditory brainstem response, and treatment.

RESULTS

The coverage of the first two levels of otoacoustic emissions was 98.4 % and 99.5 %. The incidence of risk factors was 3.08 %. A total of 6.7 % of those studied in the first stage were referred to the second, and 0.7 % of those studied in the second stage were referred to testing of auditory brainstem responses. Of the patents referred to the second stage, 97.6 % attended, and of those referred to the third stage 87.1 % attended. The positive predictive value after the second session of otoemissions was 7.9 %, and the false positive rate was 3.3 %. Sensorineural and bilateral hearing loss was diagnosed in 11 children, and permanent unilateral hypoacousia was diagnosed in one child, representing an incidence of 1.38/1,000 newborns. Sixty percent were diagnosed before the age of 3 months and 100 % before the age of 7 months. Fifty percent began treatment before the age of 6 months and 90 % before the age of 1 year. Of three cochlear implants indicated, two were implanted at 11 and 13 months. The cost was 1.3 3 per child screened and 867 3 for each case diagnosed.

CONCLUSIONS

All the objectives of the first and second stages of screening were achieved. The continuity index anticipated for the third stage (87.1 vs 95 %) and access to treatment at 6 months (50 % vs 100 %) were less satisfactory, although these results compare favorably with those of previously published studies.

Control de las repeticiones en un programa de cribado auditivo universal

INTRODUCTION

To evaluate the influence of several factors in the need for retesting in the first stage of a universal auditory screening program, a prospective and statistic study is presented, specially remarking the differences found between two health systems (public and private).

PATIENTS AND METHODS

18,073 children born in the 1999-2004 period were included in the study, in the context of a universal screening protocol based on Otoacoustic emissions and ABR, and distributed into three groups depending on their place of birth (A: public hospital; B: private hospital; C: children from other region).

RESULTS

Significant differences were found between the groups (7.3% retesting in the public system and 2.4% in the private), explained by the fact that in the first group the test was performed in 74.9% of cases within 3 days after birth (when the need for repetition was 7,7%), and in the other groups the exploration was delayed up to 4-10 days in most cases (when retesting was performed only in 4.9%).

DISCUSSION AND CONCLUSIONS

Proportion of retesting in the first stage of a universal screening program is an important factor for the cost estimation of these protocols. We assume that the age at testing varies significantly this factor, and on the contrary, we know that precocious exploration (before the child leaves the hospital) increases the program covering. Therefore we conclude that the test should be delayed only in health systems needing to save resources or not able to test before discharge, and not in those wanting to guarantee the maximum covering.

Etiología de la hipoacusia severa/profunda bilateral pre/perilocutiva en cantabria

OBJECTIVE

To know the etiology of preiperlingual bilateral hearing loss in children.

MATERIALS AND METHODS

All the patients diagnosed with bilateral severe/profound, pre or perilingual hearing loss at Sierrallana and Marqués de Valdecilla Hospitals (Cantabria, Spain) during the last 20 years were included in this study.

RESULTS

A hundred patients were diagnosed with bilateral severe/profound pre/perilingual hearing loss. The most frequent etiology was hereditary (49%), followed by severe perinatal hypoxia (11%), ototoxicity (5%), meningitis (3%), hyperbilirubinemia (3%) and rubella (2%). In 21% of cases was not known.

CONCLUSIONS

The two most frequent etiologies found in severe/profound hearing loss in children in our area were hereditary and non infectious perinatal problems. Infectious disease were scarce. Will decrease when genetic test were used as clinical basis.